Scielo RSS <![CDATA[Health SA Gesondheid (Online)]]> http://www.scielo.org.za/rss.php?pid=2071-973620190001&lang=pt vol. 24 num. lang. pt <![CDATA[SciELO Logo]]> http://www.scielo.org.za/img/en/fbpelogp.gif http://www.scielo.org.za <![CDATA[<b>Perceptions of patients regarding diabetes-related health communication strategies in the Free State, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100001&lng=pt&nrm=iso&tlng=pt BACKGROUND: This study researched the perceptions of patients diagnosed with diabetes concerning diabetes-related health communication strategies in the Free State province in South Africa. The prolongation and quality of life of patients diagnosed with diabetes are affected by lifestyle choices. An enabler of risk reduction is health communication which informs, influences and motivates individuals to adopted health-focused lifestyles. AIM: This study sought to describe the perceptions of patients regarding diabetes-related health communication strategies in the Free State, South Africa. SETTING: This study was carried out in primary health care centres and community health care centres within the Free State province in South Africa. METHODS: A qualitative, descriptive and exploratory research design was used in this study. Thirty-four patients diagnosed with type two diabetes for at least a year were purposively included in this study. Semi-structured interviews in Afrikaans, English, Sotho and Xhosa were conducted. Data analysis was through inductive reasoning and thematic analysis. RESULTS: The majority of the respondents were older women having been diagnosed with diabetes for more than 5 years, with at least primary school education and of diverse South African ethnicities. The main prompting questions operationalised the term 'perception', probing their feelings, experiences and knowledge of health-related communication strategies as presented by a variety of information sources. After recording interviews, data were analysed according to themes, categories and sub-categories. CONCLUSIONS: The study highlights factors that encourage patients to seek help and foster attitudes of compliance. Practical problems regarding the management of diabetes are underlined. The role of family, as well as the patient-caregiver relationship, in the acceptance and management of the disease is revealed. Societal perception of male symptomology is shown. The study offers information to stakeholders and health care workers for continued successful management of diabetes in communities. <![CDATA[<b>A model to promote the uptake of male circumcision as an HIV-preventive measure in high HIV and low male circumcision prevalence settings</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100002&lng=pt&nrm=iso&tlng=pt BACKGROUND: Human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS) remain the leading global burden of disease, especially in Southern Africa. As such, efforts to develop innovative preventive and curative measures continue to be a global priority. Of late, the World Health Organization recognised and recommended mass male circumcision (MC) as an adjunct HIV-preventive measure in 14 selected sub-Sahara African countries. However, despite efforts to promote the uptake of MC in these countries, the uptake remains significantly below set targets. AIM: The purpose of this article is to describe the process that was followed in developing, describing and evaluating a model to promote the uptake of MC as an HIV-preventive measure in high HIV and low MC settings. SETTING: The model is designed for all settings of high HIV and low MC prevalence. METHOD: A theory-generative, qualitative, exploratory, descriptive and contextual research design was used. The process involved four distinct steps, namely concept analysis, description of relationship statements, and description and evaluation of the model using the criteria of clarity, simplicity, generality, accessibility and importance. RESULTS: The central concept was identified as 'promote the uptake of MC', and three integral constituents were identified for the process, such as transforming men's mindsets about MC, facilitating accessibility and utilisation of MC services, and maintaining a supportive social system. These formed the basis for the model. CONCLUSION: The model provides a framework of reference for healthcare providers in promoting the uptake of MC as an HIV-preventive measure in high HIV and low MC settings. <![CDATA[<b>Rooibos herbal tea: An optimal cup and its consumers</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100003&lng=pt&nrm=iso&tlng=pt BACKGROUND: Rooibos types and forms and how prepared and flavoured influence the total polyphenol content and total antioxidant capacity (TAC). AIM: To denote an optimal rooibos cup as having the highest total polyphenol content and TAC, considering the different types, forms, preparation methods and flavourings and amounts (Phase 1), and determine the demographic, lifestyle and rooibos consumption characteristics of adult rooibos consumers, and the association of these characteristics with drinking the optimal cup (Phase 2). SETTING: Assays: Oxidative Stress Research Centre, Cape Peninsula University of Technology; Consumer survey: George area, South Africa METHOD: Phase 1 entailed determining the total polyphenol content (Folin-Ciocalteau method) and TAC (Trolox equivalent antioxidant capacity and ferric-reducing antioxidant power assay) of the prepared rooibos samples. For Phase 2, a developed, pilot tested questionnaire was used to profile adult rooibos consumers. RESULTS: Phase 1: the following samples delivered higher total polyphenol content and TAC: green (type), green leaves and powdered extract (forms), and sample steeped for 10 min or longer (preparation method). The identified optimal cup was sample steeped for 10 min or longer. Phase 2: a total of 308 respondents completed the questionnaire. Few consumed more than one rooibos cup per day (25.3%; n = 78) and the optimal cup (15.9%; n = 49). These latter respondents comprised those who steeped rooibos in a teapot (not a cup or mug) (p < 0.05). CONCLUSIONS: The optimal cup was identified as sample steeped for 10 min or longer. The rooibos consumers did not consume it sufficiently, nor steeped it long enough. <![CDATA[<b>Secondary school teachers' experiences related to learner teenage pregnancies and unexpected deliveries at school</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100004&lng=pt&nrm=iso&tlng=pt BACKGROUND: The incidence of learner teenage pregnancies can be reduced, provided that the major stakeholders, which include the Department of Education and the Department of Health, combine to address this issue. Despite the implementation of Life Orientation as a school subject, which focuses on sexual behaviour, health, decision-making, pregnancy risk, sexually transmitted infections and HIV and AIDS, the prevalence of learner teenage pregnancies at secondary schools remains alarmingly high. AIM: The purpose of this study was to explore and describe teachers' experiences of learner teenage pregnancies in secondary schools in a province in South Africa. SETTING: Secondary schools in KwaZulu-Natal. METHOD: A qualitative approach with exploratory, descriptive and contextual strategies was used in this research. Semi-structured interviews were conducted with teachers who had been selected through purposive sampling. Tesch's steps of systematic open coding were used to analyse all of the interviews. RESULTS: The results that emerged during the data analysis indicate that firstly, teachers' experiences of having pregnant learners in their classrooms are negative as these learners are frequently absent from school, perform badly and drop out of school. Secondly, teachers' experiences related to unexpected deliveries are coloured by their lack of the necessary skills and competencies to deal and their resultant insecurity. Thirdly, the teachers feel that they do not receive the assistance they need to deal with teenage pregnancies as well as unexpected deliveries. CONCLUSIONS: Collaboration between and continuous support from the Department of Health and the Department of Education are crucial if teenage pregnancies at secondary schools are to be handled with greater success. Support from health care personnel should include guidance on contraception and health campaigns should target both the teachers and secondary school learners. Furthermore, coping strategies for the teachers should form part of the preservice curriculum of teachers. <![CDATA[<b>The clinical environment</b><b>: </b><b>A facilitator of professional socialisation</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100005&lng=pt&nrm=iso&tlng=pt BACKGROUND: Competencies of health care workers, including nurses, often do not meet the health needs of populations. The clinical learning environment (CLE) is vital in socialising neophyte student nurses to display the desired competencies. Student nurses are however confronted with challenges, especially in the CLE, during this process. AIM: This article shares three validated guidelines to support professional nurses and nurse educators in facilitating appropriate professional socialisation of student nurses in the CLE. SETTING: The study was conducted in an 832-bed academic hospital and nine nursing education institutions (NEIs) that offered the nursing programme concerned in a province in South Africa. METHOD: A sequential, exploratory, mixed-methods study was conducted and qualitative data were collected from two purposive samples, consisting of seven focus group interviews and field notes. Five themes that emerged from the integrated data guided the instrument design to collect data quantitatively from 277 educators. Experts validated 10 guidelines to a set of criteria, which was developed combining all data. RESULTS: Qualitative and quantitative research evidenced that the CLE mostly did not support student nurses during professional socialisation. A few role models' behaviour was noteworthy, while student supervision was inadequate. The CLE was stressful, lacked in resources, marked by uncoordinated student placement, insufficient communication and inadequate preparation of student nurses. This evidence informed the development of the guidelines. CONCLUSIONS: The guidelines were (1) the empowerment of role models through reflective practice, (2) capacity building of professional nurses and nurse educators as clinical supervisors by means of intervention strategies and (3) adopting a multifaceted approach in the creation of a positive CLE. These guidelines could facilitate appropriate professional socialisation of student nurses. <![CDATA[<b>Perceived effectiveness of complementary medicine by mothers of infants with colic in Gauteng</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100006&lng=pt&nrm=iso&tlng=pt BACKGROUND: Infantile colic is a self-limiting condition, characterised by spasmodic, excessive and inconsolable crying without apparent cause. Although common, there is no widely accepted conventional treatment approach for colic. Complementary medicine is often promoted as an alternative therapeutic option for infantile colic; however, there is limited research available on its use, safety and effectiveness. AIM: The aim of this study was to determine the perceived effectiveness of complementary medicine by mothers of infants with colic by means of the Infantile Colic Questionnaire. SETTING: Mothers of infants who had colic were recruited from complementary medicine pharmacies, schools, baby clinics and various businesses in Gauteng, South Africa. METHODS: A quantitative-descriptive design was used whereby data was collected through a randomised, cross-sectional questionnaire. The research sample consisted of 152 participants (mothers), aged between 18 and 45 years, with one or more children who suffered from symptoms of infantile colic, who had used complementary medicine as a form of treatment. RESULTS: Results indicated that most participants made use of both complementary and conventional medicines for their infant's colic; the most commonly used complementary medicine products were homeopathic remedies, probiotics and herbal medicines. Some participants were, however, unfamiliar with the term 'complementary medicine', indicating a need for further patient education. CONCLUSIONS: The participants perceived complementary medicines as safe and effective forms of treatment for infantile colic. However, further, larger scale studies should be conducted to validate this finding. <![CDATA[<b>Experiences of women enrolled in a prevention of mother to child transmission of human immunodeficiency virus infection programme in Zimbabwe</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100007&lng=pt&nrm=iso&tlng=pt BACKGROUND: Prevention of mother-to-child transmission (PMTCT) programmes have been reported to reduce the rate of transmission of human immunodeficiency virus (HIV) infection by 30% - 40% during pregnancy and childbirth. The PMTCT transmission is achieved by offering HIV prophylaxis or initiating antiretrovirals to pregnant women who test HIV positive. Being aware of the experiences of these women will assist in planning and implementing the relevant care and support. The study was conducted in three phases. AIM: This article will address phase 1 which is to explore and describe the experiences of pregnant women living with HIV. SETTING: The study setting was a PMTCT site in a Provincial Hospital, in Zimbabwe. METHODS: The study design was qualitative, exploratory, descriptive and contextual. In-depth face-to-face interviews were conducted from a purposive sample of 20 pregnant women. Thematic data analysis was performed. RESULTS: Six themes emerged: realities of disclosure, a need for quality of life, perceived stigmatisation, inadequate knowledge on infant feeding, continuity of care, empowerment and support CONCLUSIONS: The study concluded that pregnant women living with HIV require empowerment and support to live positively with HIV. <![CDATA[<b>Experiences of student nurses regarding the bursary system in KwaZulu-Natal province, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100008&lng=pt&nrm=iso&tlng=pt BACKGROUND: During 2010, the South African nursing education system was restructured, changing student nurses from having supernumerary status to being bursary holders. Changes with the introduction of this new bursary system included institutional factors and benefits that could be removed from the students, potentially hampering students' sense of belonging. AIM: This study aimed to describe the experiences of students receiving bursaries in KwaZulu-Natal (KZN) province and to make recommendations for improving the system to bursary providers, educational institutions and practical settings based on these students' experiences of the bursary system. SETTING: The experiences of student nurses regarding the bursary system are described within a specified setting comprising two nursing campuses in KZN. METHOD: A qualitative study design was used and seven focus group interviews were conducted with purposively selected participants, representing the target population of first-, second- and third-year male and female nursing students registered for the Diploma in Nursing (General, Psychiatric, Community) and Midwifery. RESULTS: Two main themes and eight subthemes were identified. The findings indicated that some of the bursary system's experiences were negative as opposed to students having supernumerary status. These experiences had negative socio-economic, psychological, clinical, academic and family impacts. Many concerns related to staff members' attitudes, shortages of nurses and service demands during students' clinical practice assignments. CONCLUSIONS: The bursary system was not viewed as being beneficial to students as they did not receive all the benefits from being bursary holders. Support in clinical and academic areas was lacking as they were considered to be employees during their clinical assignments. There is an urgent need to review the bursary system. <![CDATA[<b>Community pharmacists' knowledge, attitude and practices towards the use of complementary and alternative medicines in Durban, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100009&lng=pt&nrm=iso&tlng=pt BACKGROUND: Atopic eczema (AE) is a common skin disease with an increasing worldwide prevalence, which has almost doubled over the last decade in South Africa. Many patients commonly explore complementary and alternative medicines (CAM) for AE and often initially seek advice from their local pharmacists. AIM: To explore the knowledge, attitude and practices amongst community pharmacists regarding CAM. SETTING: The study was conducted amongst pharmacists working in community pharmacies in Durban, South Africa. METHODS: During 2016, a cross-sectional study was conducted amongst 158 randomly selected pharmacists, of which 82 responded. Respondents were sent an email with a link to the questionnaire. Where logistically possible, questionnaires were hand-delivered RESULTS: The majority of respondents were male (n = 46; 56%), aged between 31 and 40 years. Despite most pharmacists not being familiar with various CAMs for AE, many (43%) recommend them, and 50% were amenable to referring patients to CAM practitioners. Despite 51% reporting that patients do ask about CAM for AE, 54% are not confident discussing or initiating discussions with patients. More than half of the pharmacists (55%) had no CAM training but believed it is essential for inclusion in the undergraduate pharmacy curriculum. Most were interested in broadening their knowledge on CAM and felt it would better prepare them in counselling their patients. CONCLUSIONS: The study demonstrated poor knowledge and communication about CAM for AE between pharmacists and patients, although pharmacists exhibited strong interests in learning more about CAM. There is a continuing need for education programmes and inclusion into undergraduate curricula that would assist pharmacists to advise patients on different types of CAMs. <![CDATA[<b>An assessment of infant medication administration and storage practices in selected communities in the Vhembe District of Limpopo Province, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100010&lng=pt&nrm=iso&tlng=pt BACKGROUND: Effective infant medication administration and storage is a major public health challenge outlined by the World Health Organization. These challenges may be exacerbated in rural or limited-resource areas. AIM: The aim of this study was to investigate infant medication administration and storage practices. SETTING: This study took place in selected communities in the Vhembe District of Limpopo Province, South Africa. METHOD: Data was collected through 39 semi-structured interviews with infant caretakers and rural health workers. Interviews were recorded when permission was given by participants. Interviews were transcribed and coded using grounded theory and Tesch's model of data analysis. Themes were agreed upon through consensus discussions with the researchers and an independent coder. RESULTS: Six themes that affect current infant medication administration and storage practices in the Vhembe District were identified: access to infant healthcare, the role of health workers, the devices used in the administration of infant medication, reluctance of the infant to take the medication, storage and reuse of infant medication in the rural home and hygiene practices surrounding infant medication administration. CONCLUSIONS: Many factors were found to affect infant medication administration and storage practices in in the Vhembe District. Substantial evidence was found to suggest that the relationship between rural health workers and infant caretakers strongly influences these practices: a great amount of reliance and trust is placed in the health worker. Ensuring proper dosage of infant medication in the rural household arose as a main concern of participants. Reuse of medication in the home and home hygiene practices surrounding infant medication administration are areas of potential future research. This future research may further inform recommendations for infant medication administration and storage practices in the Vhembe District. <![CDATA[<b>Infection control recommendations for radiology departments in Malawi</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100011&lng=pt&nrm=iso&tlng=pt BACKGROUND: Guidelines for radiographers contain recommendations related to standard infection control precautions for healthcare-associated infections (HAIs) which are a major cause of mortality and morbidity in hospital settings. However, the implementation of these recommendations has proven to be a challenge in the Malawian radiology departments, as there are no national guidelines or radiology policies for infection control AIM: This article outlines the development of infection control recommendations that could facilitate sound knowledge and practices of radiographers regarding infection control. SETTING: Radiology departments in hospitals in Malawi. METHODS: The recommendations were developed based on data from a questionnaire that measured the knowledge and practices of 62 radiographers regarding infection control as well as data from the literature. The Florence Nightingale environmental theory was used as the conceptual framework for the recommendations, while its development was based on steps of the National Institute for Health and Care Excellence. For the format of the draft recommendations, an adapted version of the Appraisal of Guidelines for Research and Evaluation II tool was used. RESULTS: Issues identified from the responses to the questionnaire and literature resulted in seven sets of recommendations: hand hygiene, personal hygiene, personal protective gear and the use of appropriate equipment, safe handling of sharps and sharp containers, decontamination and cleaning, housekeeping and routine infection control practices.. CONCLUSIONS: The recommendations can be further reviewed and implemented to improve the implementation of infection control and to reduce HAIs in resource-constrained settings. <![CDATA[<b>The use of the Socratic inquiry to facilitate critical thinking in nursing education</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100012&lng=pt&nrm=iso&tlng=pt BACKGROUND: Critical thinking is a skill that nurse practitioners are required to have. Socratic inquiry can be used to facilitate critical thinking in nursing. Nurse educators seek methods to infuse into teaching content to facilitate students' critical thinking skills, and one of such methods is the use of Socratic inquiry as a teaching method. AIM: This article aims to explore and describe how Socratic inquiry can be used to facilitate critical thinking in nursing education. SETTING: This study took place in a nursing department at a university in Johannesburg. METHODS: A qualitative, exploratory, descriptive and contextual design was used. Purposive sampling was used to draw a sample of 15 nurse educators determined by data saturation. Miles, Huberman and Saldaña's methodology of qualitative data analysis was used. Lincoln and Guba's strategies for trustworthiness and Dhai and McQuoid-Mason's principles of ethical consideration were used. RESULTS: Three main themes emerged: the context necessary for Socratic inquiry, dispositions in Socratic inquiry and strategies to use in Socratic inquiry to facilitate critical thinking skills of students CONCLUSIONS: Socratic inquiry can be used both in education and practice settings to facilitate the use of critical thinking skills to solve problems. <![CDATA[<b>Health and educational achievement of school-aged children: The impact of anaemia and iron status on learning</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100013&lng=pt&nrm=iso&tlng=pt BACKGROUND: Anaemia is a common blood disorder in children and is known to cause complications such as lethargy and stress on bodily organs. Children from disadvantaged communities often fail to achieve their age-related potential with iron deficiency anaemia stated as a risk factor through causing inattentiveness and learning problems. Limited evidence exists for the adverse effects of iron deficiency anaemia on the developing child's brain from South African studies. AIM: The objective of this study was to determine the local prevalence of anaemia and iron deficiency and to examine their association with psychomotor development and school performance in school-aged children. SETTING: This study was conducted in a peri-urban disadvantaged community from KwaZulu-Natal, South Africa. METHODS: Children aged 6 to 8 years from KwaZulu-Natal were enrolled (n = 184). Three parameters of assessment were used: clinical data, biochemical data (haemoglobin levels and iron studies) and school performance (interviews with caregivers, teachers and the children). Anaemia presence and iron deficiency were the hypothesised mediating variables through which growth, development and school performance were influenced. RESULTS: A high point prevalence of anaemia (23.4%), iron deficiency anaemia (4.9%) and helminth infection (27.1%) was identified. Impaired cognitive assessment scores (20.7%) were prevalent in the children sampled. Behavioural problems (4.3%), poor memory function (4.3%) and impaired attention (1.1%) were of low prevalence. Anaemia and iron deficiency were both associated with impaired fine motor skills (p < 0.05). Anaemia was significantly associated with low cognitive scores (p = 0.01). Neither anaemia, iron status nor helminth infection significantly predicted school performance in the children sampled. CONCLUSIONS: The point prevalence of anaemia and iron deficiency among the sampled children was higher than the national prevalence. The sample size was however inadequate for drawing statistical conclusions about psychomotor development and school performance because of the low prevalence of the different outcomes that were examined. Practical challenges faced in conducting this investigation in rural South African schools were discussed. <![CDATA[<b>Self-managing individual wellness for the health professional: A somatology perspective</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100014&lng=pt&nrm=iso&tlng=pt BACKGROUND: Health professionals play a vital role in the stability and sustainability of any healthcare system. However, the well-documented long working hours, lack of wellness support structures, regular occurrence of burnout and low retention rates are concerning. AIM: The aim of this research study was to understand how a group of therapists self-manage their own individual wellness, to provide insight on how other health professionals, working in a demanding environment, could potentially address their individual wellness more effectively. SETTING: The research was conducted in a private room at the place of participant employment, in two metropolitans in Gauteng, South Africa. METHOD: Qualitative, explorative, descriptive and contextual designs were used within the paradigm of constructivism. Purposive sampling was used to select participants. Data were collected through in-depth interviews, field notes and reflective practices, and analysed through open coding. RESULTS: This study revealed disequilibrium between the theoretical knowledge and practical realities of therapists, and indicated that these therapists experience various personal obstacles that hinder the self-management of their individual wellness. CONCLUSIONS: Somatology therapists use various personal strategies that allow them to better self-manage their individual wellness. Individual wellness seems to be a personal phenomenon, indicating the need to self-reflect on personal perceptions of wellness, individual wellness obstacles and individual wellness strategies to effectively self-manage individual wellness. <![CDATA[<b>Traumatic incident reduction: A suitable technique for South African social work practice settings</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100015&lng=pt&nrm=iso&tlng=pt It is part of South African social workers' responsibilities to attend promptly and appropriately to victims of trauma. Overstrained and limited resources in communities influence the availability of debriefing services to traumatised community members. The purpose of this article was to elaborate on the traumatic incident reduction (TIR) technique as a suitable, short-term intervention technique for social work practice settings to address the impact of trauma effectively and timely. A discussion on TIR is presented by contextualising and defining mental health and post-traumatic stress disorder (PTSD) and elaborating on other practice approaches, therapies, techniques and models for addressing trauma and PTSD in social work practice. Given the excessive exposure to trauma experienced by the South African population, it is clear that further trauma counselling services are required and more effective ways must be found to empower communities to deal with trauma. Most approaches for the treatment of trauma in South Africa are specialised and resources are limited; therefore, many communities are excluded from these specialised services. The TIR technique fits appropriately within the ambit of the developmental approach, as embraced by the South African Department of Social Development. It will be beneficial if social workers, auxiliary social workers, community leaders, community volunteers, health care workers and lay counsellors are trained in the TIR technique. Concerted efforts are necessary to empower communities in supporting themselves and developing the necessary skills to address trauma. This initiative will be consistent with the developmental approach sanctioned by the Department of Social Development. <![CDATA[<b>Therapeutic play as a qualitative data generation method: A critical reflection</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100016&lng=pt&nrm=iso&tlng=pt BACKGROUND: Child-centred research requires researchers to develop research designs that will enable children to express their views in an ethical, appropriate and child-friendly manner and generate rigorous findings. These requirements challenge researchers to develop new methods to generate data with children, and the 'younger the child, the more intense the challenge'. AIM: The aim of this article was to describe and reflect on the use of therapeutic play as a data generation method by nurse researchers with young children in a child-centred qualitative, explorative, descriptive and contextual study using a multiple case study strategy SETTING: The study was conducted with young children attending an outpatient department at a public hospital in Gauteng. METHODS: Four young children, purposively sampled, participated in six sessions, each based on therapeutic play grounded in the work of Oaklander's Gestalt play therapeutic approach, facilitated by a nurse researcher. Critical reflection was made about the play therapeutic approach as a data generation method, based on its ability to generate useful data, its implications for data analysis and its ability to be child-enabling and child-centred. RESULTS: The play therapeutic approach, as a data generation method, is capable of generating useful data and amplifying children's voices in the process. CONCLUSIONS: The nurse researcher needs to be highly skilled in this approach as it requires the ability to implement the specific play therapeutic approach in a safe and skilful manner. <![CDATA[<b>Sense of coherence in Chinese and German students</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100017&lng=pt&nrm=iso&tlng=pt BACKGROUND: Mental health and salutogenesis are important topics at universities in China and Germany where heightening stress levels in students can be observed AIM: The aim of this article is to determine the profile of the salutogenic concept, sense of coherence (SOC), in Chinese and German students to provide new insights into SOC and mental health in Chinese and German students in higher education institutions (HEIs SETTING: The study was carried out at universities in China and Germany METHOD: A non-experimental, cross-sectional, survey-based research design and convenience sampling was utilised to obtain the sample (n = 356). The sample was derived at a selected Chinese (n = 255) and a selected German university (n = 101). Data were gathered using the 7-point Likert SOC dimension scales based on the Life-Orientation Questionnaire (LOQ) research instrument. The internal consistency levels of the SOC sub-scales were of acceptable levels. Descriptive and inferential statistics were used to analyse the data. Cronbach's alpha coefficients were calculated to determine the reliability of the LOQ research instrument. General linear modelling techniques RESULTS: The results showed the Chinese students scored significantly lower in all three SOC scales than the German students, with the largest practical significant difference in the sub-score of meaningfulness. In general, female Chinese and German students scored higher than their male counterparts. No significant differences could be found between German female and male, and Chinese female and male students CONCLUSION: Conclusions and recommendations for future research and HEI practice are provided <![CDATA[<b>Nurses' perspectives about communication with patients in an intensive care setting using a communication board: A pilot study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100018&lng=pt&nrm=iso&tlng=pt BACKGROUND: Communication in the intensive care setting (ICS) is critical for both the patient and the medical staff to provide efficient care and thus alleviate possible patient adverse effects. Persons with complex communication needs are particularly vulnerable in ICSs and therefore require additional communication support AIM: This study focused on the perspectives of nurses about communication with patients with communication needs in ICSs using paper-based communication boards, namely the translated Vidatak EZ Board, before and after a training session SETTING: A 1650-bed public hospital with a 26-bed ICS in a semi-urban, low socio-economic area in South Africa served as the research setting METHODS: A quasi-experimental pre-test post-test group design with withdrawal and a control group was used. Data were gathered using a custom-designed questionnaire completed by ICS nurse participants recruited from a public hospital RESULTS: Responses of some nurses did not change in post-test 1, but their responses did change in post-test 2. Some of the nurses' perspectives changed, as expected from the pre-test to post-test 1. Nurses recommended specific adaptations to the communication board CONCLUSIONS: Most nurses agreed that communication is crucial in ICSs and that a communication board can be implemented; however, limited success was observed implementing the board following a short training. The inter-professional collaboration between nurses and speech-language therapists to provide optimal health care to patients in ICS is emphasised <![CDATA[<b>Comparison of patient satisfaction with pharmaceutical services of postal pharmacy and community pharmacy</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100019&lng=pt&nrm=iso&tlng=pt BACKGROUND: The growing drive in South Africa to contain medicine cost has seen the emergence of postal pharmacy as an alternative mechanism to dispense chronic medicines. Patient satisfaction with pharmaceutical services has received limited attention in South Africa AIM: The aim of this study was to compare the level of patient satisfaction with pharmaceutical services between postal and community pharmacies. SETTING: The research was conducted in the eThekwini Municipality, KwaZulu- Natal Province, South Africa in July and August 2014. METHODS: A cross-sectional quantitative study using a randomised, telephonic questionnaire survey was conducted. Selected land telephone numbers were called until a sample size of 250 community pharmacy participants and 125 postal pharmacy participants was obtained RESULTS: Nine hundred and five telephone calls were made to obtain a sampling frame of 375 (41.44%) respondents, 250 for community and 125 for postal. After adjusting overall satisfaction by removing financial satisfaction, there was no significant difference between satisfaction in the two groups (p = 0.471). Postal pharmacy participants reported a higher level of financial satisfaction (p = 0.001). Community pharmacy participants reported a higher level of satisfaction with counselling or explanation (p = 0.028) and less medicine wastage (p < 0.001. CONCLUSIONS: Patient satisfaction with pharmaceutical services provided by either community or postal pharmacy was not significantly different. However, community pharmacies tend to address patients' specific concerns more effectively. With the move to National Health Insurance, policymakers need to ensure that they provide high-quality pharmaceutical services and are more inclusive of community pharmacies to deliver quality care. <![CDATA[<b>Challenges of women refugees in utilising reproductive health services in public health institutions in Durban, KwaZulu-Natal, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100020&lng=pt&nrm=iso&tlng=pt BACKGROUND: Reproductive health services are essential for everyone worldwide. In South Africa, the available literature does not address reproductive health as a full package for women refugees and their experiences. This study addressed women refugees in relation to reproductive healthcare services they receive from public healthcare facilities. AIM: The aim of the study was to document the day-to-day experiences of women refugees and uncover their challenges regarding utilisation of reproductive health services in public institutions of Durban, KwaZulu-Natal. SETTING: The study was conducted in eThekwini district, Durban, KwaZulu-Natal, and did not consider participants who are located beyond the above-mentioned city's borders. METHODS: A qualitative, descriptive design was used. A semi-structured interview guide was used to collect data through face-to-face in-depth interviews with eight women refugees. Thematic content analysis guided the study. RESULTS: Two major themes emerged: negative experiences or challenges, and positive experiences. The most dominant negative experiences included medical xenophobia and discrimination, language barrier, unprofessionalism, failure to obtain consent and lack of confidentiality, ill-treatment, financial challenges, internalised fear, religious and cultural hegemony, and the shortage of health personnel and overcrowding of public hospitals. The positive experiences included positive treatment and care and social support. CONCLUSION: The findings revealed that women refugees in Durban, KwaZulu-Natal, face many challenges such as medical xenophobia and discrimination in their attempt to seek reproductive health services in public healthcare facilities, making them even more vulnerable. Assisting women refugees with their reproductive health needs will remediate the challenges they face. <![CDATA[<b>A radiographic criteria checklist to determine reasons for errors, resulting in sub-optimal routine shoulder projections</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100021&lng=pt&nrm=iso&tlng=pt BACKGROUND: Optimal shoulder images must adhere to specific radiographic criteria before they are sent to the radiologist for reporting. Repeat x-rays of the shoulder may increase radiation exposure to the patient. AIM: The aims of this study were to determine whether images adhered to the required radiographic criteria for routine shoulder imaging and to identify possible reasons for non-adherence. SETTING: The study was conducted at an imaging department at a tertiary academic hospital in Bloemfontein, South Africa. METHODS: A criteria checklist compiled from literature was used to evaluate 578 routine shoulder images including anteroposterior (AP) with external rotation and lateral-Y (LAT-Y) projections. The checklist determined whether the shoulder images adhered to the criteria with regard to the anatomy included, positioning and technical factors, such as inclusion of the correct anatomical lead marker. Data were analysed using SAS Version 9.2 statistical software. RESULTS: More than 80% of the AP external rotation images included unnecessary anatomical structures owing to incorrect centring. In four out of seven criteria pertaining to positioning for AP external rotation imaging, at least 70% of images were performed incorrectly. Four-sided collimation was not present in more than 50% of both AP external rotation and LAT-Y images because of incorrect centring, while more than 30% of shoulder images presented with anatomical digital markers. CONCLUSION: The application of criteria required for shoulder imaging must be addressed at the participating imaging department to improve overall patient care. An in-service training session is recommended to enhance the radiographic technique with regard to routine shoulder projections. <![CDATA[<b>The use of clickers to evaluate radiographer's knowledge of shoulder images</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100022&lng=pt&nrm=iso&tlng=pt BACKGROUND: Conducting research can be daunting, although applicable methods can facilitate the process. A study was performed at an imaging department pertaining to the routine shoulder projections, namely the anteroposterior (AP) external rotation and lateral-Y (LAT-Y) projections. AIM: The aim of the study was to determine if radiographers (qualified, supplementary, community service) and student radiographers (second-year diploma, third-year diploma, second-year bachelor) use the radiographic evaluation criteria to evaluate the routine shoulder projections. SETTING: The study was conducted at an imaging department in the Free State province, South Africa. METHODS: Participants had to complete a survey by means of a questionnaire that was compiled in Microsoft Excel and converted to an audience response system known as clickers. The questions addressed aspects of shoulder imaging with regard to positioning, exposure factors and the evaluation of routine shoulder projections. The data were analysed separately using statistics software SAS Version 9.2. Fisher's exact test was used to determine statistically significant differences between students and radiographers RESULTS: More than 80% of students selected the AP (external rotation) X-ray image demonstrating optimal milliamperage per second whereas 43% of radiographers selected the correct image. More than 50% of radiographers and students indicated that a breathing technique and a short exposure time reduce motion during shoulder imaging. CONCLUSION: Using clickers eased the process of testing the participants' knowledge, and the results were available immediately after completion of the test. Clickers can contribute to and expedite the process of data analysis. <![CDATA[<b>The influence of language of instruction in the facilitation of academic activities: Nurse educators' experiences</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100023&lng=pt&nrm=iso&tlng=pt BACKGROUND: Learners in most South African higher education institutions are taught mainly through English for most of their academic lives, yet many of them enter these institutions with poor proficiency in this language of instruction (LOI). AIMS: The purpose of this article was to describe the experiences of nurse educators teaching in a 4-year comprehensive nursing diploma programme regarding the use of English as the LOI during academic activities. SETTING: The nursing college under study offers a 4-year comprehensive nursing diploma programme as well as post-basic diploma qualifications such as Primary Health and Midwifery Nursing Science and is situated in Gauteng, South Africa. METHODS: Twenty nurse educators were purposively sampled for in-depth individual interviews until data saturation and were requested to participate in the study. Tesch's protocol of qualitative data analysis was used and the themes that emerged were confirmed by an independent coder. Trustworthiness was ensured, and ethical considerations were adhered to. RESULTS: It emerged that English language incompetence (1) undermines learners' self-esteem; (2) hinders critical, reflective and creative thinking; (3) renders understanding difficult and that (4) nurse educators' incompetence in LOI hinders meaningful teaching. CONCLUSIONS: Recommendations were made to improve the use of the LOI because through language interdisciplinary knowledge and understanding are integrated, thus ultimately providing patients with comprehensive, holistic and transcultural healthcare. <![CDATA[<b>Group-based intervention in a primary healthcare setting was more effective for weight loss than usual care</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100024&lng=pt&nrm=iso&tlng=pt BACKGROUND: Literature and practice recommendations for lifestyle interventions to treat the increasing number of obese patients with non-communicable diseases (NCDs) or risk factors for NCDs attending resource-constrained public healthcare facilities in South Africa are scarce. AIM: To compare the impact of a facility-based therapeutic group (FBTG) intervention with usual care on weight in obese participants, with NCDs or risk factors for NCDs SETTING: Public healthcare facility providing primary healthcare services in Cape Town, South Africa. METHODS: A quasi-experimental study design was used where participants chose to receive weight loss treatment with either the FBTG or usual care interventions. Both interventions involved a one-on-one medical and dietetic consultation, while FBTG participants had six additional group sessions. Follow-up assessments took place 6 months after baseline. Socio-demographic variables, blood pressure, smoking status, weight, height, waist circumference, dietary intake, physical activity and stage of change were measured. RESULTS: Of the 193 obese adults enrolled, 96 selected the FBTG and 97 selected usual care. There were no significant differences at baseline between the two groups. Weight loss over 6 months was greater (p < 0.001) in FBTG (median [IQR] of −2.9 [−5.1; −0.3] kg) than usual care (−0.9 [−0.9; 0.6] kg) participants. At 6 months, more FBTG completers reached the weekly target of 150 min (p = 0.009), while both groups showed improvements in dietary intake. More FBTG (74%) than usual care (49%) participants were in the action stage of change by 6 months (p = 0.010). CONCLUSIONS: The group-based intervention was more effective than usual care in weight reduction as well as improvements in physical activity and stage of change. <![CDATA[<b>Sensory processing disorder: Perceptions on the clinical role of advanced psychiatric nurses</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100025&lng=pt&nrm=iso&tlng=pt BACKGROUND: No description of the clinical role of the advanced psychiatric nurse in the management of children with sensory processing disorder could be found for the South African context. This is a loss in clinical nursing practice with regard to diagnosis, treatment and research AIM: To explore and clarify the perceptions of healthcare professionals in South Africa on the clinical role of the advanced psychiatric nurse in sensory processing disorder to provide a description of this role SETTING: The research was conducted by inviting registered healthcare professionals practicing in South Africa to complete several rounds of an on-line survey METHODS: An explorative and descriptive design was used. Purposive sampling was used to identify an initial sample of healthcare professionals, followed by snowball sampling. The Delphi technique was implemented with three sequential rounds, gathering data on the perceptions of the healthcare professionals regarding the clinical role of the advanced psychiatric nurse in sensory processing disorder RESULTS: The following main themes crystallised from the data - (1) Specialised training of the advanced psychiatric nurse (APN) on sensory processing disorder; (2) Interventions carried out by the APN with regard to sensory processing disorder; (3) Adequate support to the family with regard to sensory processing disorder; and (4) Referral of a child with sensory processing disorder CONCLUSION: The study indicates that the healthcare professionals who are experts in delivering healthcare to children with sensory processing disorder agree that the APN with additional training in this condition has a clinical role to play in rendering healthcare to these healthcare users. A preliminary clinical role description could be formulated. Recommendations for nursing practice, nursing education and further research were formulated <![CDATA[<b>A conceptual framework to guide public oral health planning in Limpopo province</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100026&lng=pt&nrm=iso&tlng=pt BACKGROUND: There is limited understanding of the complexities surrounding public oral health service delivery in South Africa and the resulting impact on oral health outcomes. AIM: This study aimed to identify the strengths and challenges in oral health decision-making within the public health sector and to propose a conceptual framework to guide oral health service delivery in the province. SETTING: This study was performed in the Limpopo province. METHODS: National and provincial health policy documents were reviewed to identify statements on oral health service delivery. A face-to-face, semi-structured interview was conducted with the Limpopo Provincial Manager of Department of Health, Oral Health Services. Data were collected on oral health policies and the organisational structure of public oral health services. A self-administered questionnaire was completed by five district managers of public oral health services to obtain data on the delivery of public oral health services in Limpopo province. RESULTS: The results indicated that oral healthcare was not explicitly mentioned, included or referred to in the examined health policy documents. The interviews indicated that public oral health services do not have a dedicated budget and were not considered a priority. The questionnaire results revealed challenges in infrastructure, human resources and perceived marginalisation from the healthcare services. Participants agreed that there was a need for oral health to be clearly expressed and prioritised in health policy statements. CONCLUSION: This study proposed a framework that incorporated the identified core components that influenced oral health services provision in Limpopo province. <![CDATA[<b>Caregivers' perceptions of the oral-health-related quality of life of children with special needs in Johannesburg, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100027&lng=pt&nrm=iso&tlng=pt BACKGROUND: The prevalence of dental caries and its effect on the oral-health-related quality of life (OHRQoL) of children with special needs (CSNs) have not been established in South Africa. AIM: The study aimed to assess how caregivers of CSNs who attended Down Syndrome Association outreach sites in Johannesburg, South Africa, perceived the contribution of OHRQoL to the quality of life of these children. SETTING: The study was conducted at Down Syndrome Association (DSA) outreach sites in Johannesburg. These sites cater for children with several types of disabilities including cerebral palsy, hydrocephalus, autism, epilepsy and developmental delays. The association schedules and facilitates support group meetings for the caregivers of children with Down syndrome and other disabilities. These meetings are held at the outreach sites that are located at different district hospitals and community health centres in Johannesburg and are co-facilitated by the association's outreach coordinator together with a team of physiotherapists, occupational therapists and speech therapists. METHODS: This cross-sectional study was composed of a convenient sample of 150 caregiver and child pairs from five outreach sites during January - June 2015. The short-form Parent-Caregiver Perception Questionnaire (P-CPQ) was used. The caries status of the children was assessed using the decayed, missing and filled teeth (dmft/DMFT) indices (whereby dmft or DMFT stands for decayed missing filled teeth in primary dentition [dmft] and in permanent dentition [DMFT]) based on World Health Organization guidelines. RESULTS: The mean age of the caregivers was 39.52 years (standard deviation [SD] 9.26) and 8.72 years (SD 6.07) for the children. The mean P-CPQ score was 12.88 (SD 12.14). All the caregivers stated that dental caries had a negative impact on the OHRQoL of the CSNs. However, 60% of caregivers stated that an oral condition had no impact on the child's overall well-being. The majority (56.7%) of the caregivers rated their children's overall oral health status as average and only 12% reported the oral health status to be poor. There was a high prevalence of untreated caries among the CSNs regardless of the type of disability. CONCLUSION: All the caregivers stated that dental caries had a negative impact on the OHRQoL of the CSNs. However, they appeared to have contradictory perceptions of the oral health needs or status of their children. <![CDATA[<b>Second and third year medical students' self-reported alcohol and substance use, smoking habits and academic performance at a South African medical school</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100028&lng=pt&nrm=iso&tlng=pt BACKGROUND: Health professional students frequently use alcohol and narcotics. The potential impact on academic performance and professional behaviour is concerning. AIM: This study aimed to determine self-reported use of alcohol, illicit substances (e.g. cannabis, lysergic acid diethylamide [LSD], magic mushroom, cocaine, crack, ecstasy, methamphetamine and heroin), prescription medication and smoking habits, correlating academic performance. SETTING: Faculty of Health Sciences, University of the Free State. METHODS: An observational, descriptive, cross-sectional study design was used. Information was obtained using a self-administered questionnaire, capturing demographics, self-reported academic performance, drinking and smoking habits, and substance use. Coded responses were analysed using the Remark Office OMR 8 Software System. Descriptive statistics were calculated for categorical variables. RESULTS: Completed questionnaires comprised 171 students. A total of 78.4% of second year and 82.8% of third year students reported using alcohol. Twenty-two per cent of second year and 24.1% of third year students reported cannabis use. In the second year group, three (2.7%) students reported using magic mushroom, two (1.8%) reported cocaine, two (1.8%) reported ecstasy and one (0.9%) reported using methamphetamine. Only third year students reported using LSD or 'crack'. Cigarette smoking was common - 31.5% and 35.1% in both groups, respectively. Smokeless tobacco devices were used by 8.5% of second year and 7.1% of third year students. Almost 40% of both groups reported that they had smoked a water pipe. Academic performance achieved was mostly 60% - 69% (38.9%) among second year students and 70% - 79% (46.6%) among third year students. CONCLUSION: Self-reported use of alcohol and drugs and smoking among medical students is alarming. Additional student support, early identification and referral for management and/or rehabilitation should be a priority at tertiary institutions responsible for training future healthcare professionals. <![CDATA[<b>Manual therapy interventions in the treatment of plantar fasciitis: A comparison of three approaches</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100029&lng=pt&nrm=iso&tlng=pt BACKGROUND: Plantar fasciitis is one of the common causes of heel pain and a common musculoskeletal problem often observed by clinicians. Numerous options are available in treating plantar fasciitis conservatively, but no previous studies have compared combined conservative management protocols. AIM: The aim of this study was to compare manipulation of the foot and ankle and cross friction massage of the plantar fascia; cross friction massage of the plantar fascia and gastrocsoleus complex stretching; and a combination of the aforementioned protocols in the treatment of plantar fasciitis. SETTING: This study was conducted at the University of Johannesburg, Chiropractic Day Clinic, and included participants that complied with relevant inclusion criteria. METHODS: Forty-five participants between the ages of 18 and 50 years with heel pain for more than 3 months were divided into three groups and received one of the proposed treatment interventions. The data collected were range of motion (ROM) of the ankle (using a goniometer) and pain perception using the McGill Pain Questionnaire and Functional foot index and algometer. RESULTS: The results of this study indicate that cross friction massage of the plantar fascia and stretching of the gastrocsoleus complex showed the greatest overall improvement in terms of reducing the pain and disability and ankle dorsiflexion ROM, whereas the combination group showed the greatest increase in plantar flexion. CONCLUSION: The results demonstrated that all three protocols had a positive effect on the ROM and pain perception to patients with plantar fasciitis. <![CDATA[<b>The association between under-nutrition, school performance and perceptual motor functioning in first-grade South African learners: The North-West Child Health Integrated with Learning and Development study</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100030&lng=pt&nrm=iso&tlng=pt BACKGROUND: Early childhood is characterised by an immense spurt of growing and learning where under-nutrition can have adverse effects on the neuro-developmental health and school performance of children. A full understanding of the relationship between school performance and motor functioning skills and malnourishment in school beginners is still lacking. AIM: To determine the association between indices of under-nutrition and how it relates to school performance and motor functioning skills of first-grade learners. SETTING: North West province (NWP) of South Africa (SA) METHOD: The baseline data of the stratified, randomised North-West Child Health Integrated with Learning and Development (NW-CHILD) longitudinal study were used. Grade 1 learners (N = 816, 420 boys, 396 girls, mean age 6.78+ years) from four school districts in the NWP of SA took part in the study. Indices of under-nutrition were determined by Z-scores (−2 standard deviation [s.d.]) for stunting (height-for-age [HAZ]) and wasting and underweight (Z-score for body mass index) using the 2007 World Health Organization reference sample. The Bruininks-Oseretsky Test of Motor Proficiency Short Form and the Visual Motor Integration fourth edition were used to assess different aspects of motor functioning, while school performance in mathematics, reading and writing was assessed by teachers according to the National South African standards of assessments. RESULTS: Both HAZ and Z-score for weight-for-age correlated significantly with school performance and motor functioning skills (r &gt; 2.0, p < 0.05), while visual perception was moderately associated (r < 0.30) with mathematics in HAZ and Z-score for weight-for-height (WHZ) children. Motor functioning of HAZ and WHZ children was significantly poorer (p < 0.05) compared to typical children, while underweight was not associated with any outcome variables. CONCLUSION: Moderate forms of stunting and wasting influence school performance and motor functioning of school beginners negatively, while an association between visual perceptual abilities and inferior mathematics, reading and writing suggests a close link with inferior cognitive information processing in stunted and wasted children. These barriers should be addressed as poor scholastic success in Grade 1 may influence future school performance and the subsequent well-being of children. <![CDATA[<b>Dietary supplement use among dietetics students at the University of KwaZulu-Natal</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100031&lng=pt&nrm=iso&tlng=pt BACKGROUND: A dietary supplement is a product that aims to add nutritional value to the diet. University students are known to make use of dietary supplements to improve their academic performance, increase energy levels and promote overall general health. Based on assumption, students studying towards a nutrition-related degree may eat healthily and choose not to use dietary supplements. Alternatively, because of their interest in and exposure to nutrition, they may decide to use dietary supplements. However, there is a lack of published studies investigating the prevalence of dietary supplement use and reasons for use among South African university students studying towards a nutrition-related degree. AIM: The aim of this study was to assess the use of dietary supplements by dietetics students. SETTING: University of KwaZulu-Natal (UKZN). METHODS: A cross-sectional, descriptive study was conducted using a self-administered questionnaire. RESULTS: Of the 139 participants, 23% (n = 32) used dietary supplements. There was a greater use by female students, those who lived at home and those registered for the Postgraduate Diploma in Dietetics. Reasons for using dietary supplements included the following: to strengthen the immune system (62.5%), to improve energy levels (56.3%) and to enhance physical health (50%). Cost (32.7%; n = 35), an adequate diet (22.4%; n = 24) and not necessary or waste of money (15%; n = 16) were reasons for not using dietary supplements. Most students (84.4%) made use of a multivitamin and mineral supplement. CONCLUSION: There was a low prevalence of dietary supplement use by UKZN dietetics students, with the high cost of supplements given as the main reason for non-use. <![CDATA[<b>Design-based research for the development of a flexible learning environment</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100032&lng=pt&nrm=iso&tlng=pt BACKGROUND: Students enrolled for the Bachelor of Radiography degree at the Central University of Technology Free State in Bloemfontein, South Africa, spent many weeks off campus at hospitals during workplace learning. A design-based research approach was applied to analyse an educational problem, namely that students apparently fail to apply the theory of radiation safety regulations to protect themselves and patients. AIMS: The purpose of the study was to develop authentic activities and assessment for radiation safety requirements, to provide flexible learning in a blended environment to students off campus. SETTING: The second-year radiography students of 2016 and 2017 responded off campus to the QuestionPro survey. METHOD: Authentic learning and assessment opportunities were contextualised and compiled to align with learning outcomes of the safety regulations as confirmed during a Delphi process. Flexible learning opportunities were delivered via electronic mail (email) and WhatsApp. Assessment responses from the students were received via mobile phones with a Web-based software tool, QuestionPro. RESULTS: Of the 117 students, 92.3% responded to the QuestionPro survey. From the incorrect responses, learning areas that needed revision were identified, as well as the areas in the X-ray departments of the hospitals showing non-compliance with the requirements for radiation safety. CONCLUSION: The three outcomes of this design-based research included the formulation of design principles, a designed product in the form of a Website and professional development of the researcher. The design-based research principles that were tested involved the use of knowledge in real life and measuring if students were effective performers with acquired knowledge. <![CDATA[<b>Bench, bed and beyond: Communication and responsibility in decentralised tuberculosis care</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100033&lng=pt&nrm=iso&tlng=pt BACKGROUND: South Africa faces one of the world's worst drug-resistant tuberculosis epidemics. Implementing successful care in this context has proven challenging for a number of reasons. Communication is an essential yet neglected feature of care and research in the field of tuberculosis. AIM: The primary aim of this qualitative study was to explore communication facilitators and barriers at several tuberculosis care sites. In this article, we focus on communication practices across the chain of diagnosis, treatment, discharge and follow-up in decentralised care approaches and present evidence of gaps in communication. SETTING: The study was conducted at three tuberculosis care sites in two South African provinces. METHODS: Participants included healthcare workers, patients, community members and home-based carers. Data included 79 interviews, 4 video-recorded interactions between patients and healthcare workers, and ethnographic observations at each site. We analysed the data using thematic analysis and a qualitative sociolinguistic framework. RESULTS: Communication in decentralised care contexts is complex because of multiple sites and role players. Responsibility for communication seems to be unduly placed on patients, treatment guidelines are not implemented consistently across sites and assumptions are made about the role of others in the chain. Patient and healthcare worker reports suggest confusion and frustration. CONCLUSION: Communication in the South African tuberculosis care context appears fragile and current mechanisms for detecting flaws in the care chain are not sensitive to communication issues. We make recommendations for strengthening home-based care resources, providing team training and focusing on communication processes in monitoring and evaluating systems. <![CDATA[<b>Describing the perceptions of student nurses regarding barriers and benefits of a peer-mentorship programme in a clinical setting in KwaZulu-Natal</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100034&lng=pt&nrm=iso&tlng=pt BACKGROUND: Novice student nurses encounter challenges when making the transition to clinical learning because of the complex and unpredictable nature of clinical settings. A selected campus initiated a peer-mentoring programme based on research findings, which revealed that student nurses were inadequately mentored in clinical settings because of mentors experiencing work overload, time and resource constraints, staff shortage and patient-care demands. AIM: The aim of this study was to describe the perceptions of student nurses regarding barriers and benefits of a peer-mentorship programme in a clinical setting. SETTING: The study was conducted in a clinical setting in KwaZulu-Natal. METHODS: A quantitative, descriptive design was used, whereby data were collected through questionnaires. A total of 56 mentors (third- and fourth-year nursing diploma student nurses) and 94 mentees (first- and second-year nursing diploma students) participated in the study. RESULTS: The mentors highlighted insufficient practice opportunities because of the short duration of the placement, time and resource constraints, and the simultaneous mentoring of too many students as barriers, while the mentees highlighted the reluctance of mentors to fulfil their roles and lack of dedication and unfriendliness as barriers to effective mentorship. The benefits of being a mentor were self-achievement, enhancement of skills and acquiring of positive work ethics, while the major mentee benefits included experiencing less anxiety, adapting to the clinical environment easily and being less intimidated in the clinical setting. CONCLUSIONS: This study revealed that both mentors and mentees perceived peer-mentoring programmes as important to their clinical growth. However, these programmes require formative evaluations to address negative perceptions of student mentees and mentors and to identify challenges faced by them. <![CDATA[<b>Smoking habits and alcohol use of patients with tuberculosis at Standerton Tuberculosis Specialised Hospital, Mpumalanga, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100035&lng=pt&nrm=iso&tlng=pt BACKGROUND: A high prevalence of smoking and alcohol use has been reported in patients with tuberculosis (TB) by several researchers, even though these lifestyle habits have a negative impact on prognosis and treatment. AIM: To determine the smoking habits and alcohol use of patients with TB and TB/human immunodeficiency virus (HIV) co-infection, and how it is associated with gender, level of education and body mass index (BMI). SETTING: The study was conducted at Standerton TB Specialised Hospital, Mpumalanga. METHODS: A cross-sectional approach was applied. A structured interview was conducted by the researcher with each of the 100 hospitalised patients to obtain information about smoking habits, alcohol use and level of education. Weight and height were measured using standard techniques. RESULTS: Almost six out of 10 participants (58%) indicated that they were former (44%) or current (14%) smokers. Nearly half (49%) reported that they used alcohol, with 25% drinking alcohol more than three times per week. Significantly more women than men were non-smokers (60.0% vs. 30.0%) and more men drank alcohol three times or more per week than women (36.7% vs. 7.5%). Participants who indicated that they were either former or current smokers had significantly lower levels of education than participants who were non-smokers (95% confidence interval [CI] [−26.7%; −2.6%] and [−39.9%; −1.0%] respectively. CONCLUSION: A high percentage of patients with TB and TB/HIV co-infection previously or currently smoked and used alcohol. Smoking and alcohol use are likely to have a negative impact on nutritional status and may further affect the prognosis of patients with TB. <![CDATA[<b>Changes in chronic neck pain following the introduction of a visco-elastic polyurethane foam pillow and/or chiropractic treatment</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100036&lng=pt&nrm=iso&tlng=pt BACKGROUND: Sleep ergonomics are increasingly prescribed as an adjunct treatment to chronic neck pain. Postulated benefits to maintaining the ideal sleeping posture are improved tissue repair in and around the facet joints, decrease in tension of associated musculature and better quality sleep. AIM: The purpose of this study was to determine if the inclusion of a visco-elastic polyurethane (VEP) pillow could benefit the chiropractic treatment of chronic neck pain. SETTING: The study took place at a chiropractic training clinic in Johannesburg. METHOD: Participants were randomly assigned to either a chiropractic treatment only group (CHI) (n = 15) or a chiropractic treatment with a VEP pillow group (CHI+P) (n = 15). Both groups underwent six chiropractic treatments spaced at 3-4-day intervals and the CHI+P were provided with a VEP pillow. Baseline and post-test measurements consisted of the initial Numerical Pain Rating Scale (NRS) and the Vernon-Mior Neck Pain and Disability Index (NDI). RESULTS: Both the CHI and CHI+P groups significantly (p ≤ 0.05) improved their NRS (p = 0.001 for both groups) and NDI (p = 0.001 and p = 0.000, respectively) scores. Furthermore, post hoc analysis indicated a significant difference at post-test between the two groups for NRS (p = 0.015), but not for NDI (p = 0.195). The CHI+P demonstrated an improved minimum clinically important difference (MCID) (43% vs. 73% for NRS and 59% vs. 71% for the NDI CONCLUSION: Findings of this study suggest that a VEP pillow could be included as an adjunct management tool to chiropractic treatment of chronic neck pain. <![CDATA[<b>Factors hindering effective uptake of medical male circumcision at Untunjambili area in KwaZulu-Natal, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100037&lng=pt&nrm=iso&tlng=pt BACKGROUND: Before 19th century, in KwaZulu-Natal, South Africa, male circumcision was regarded as a right to passage to manhood; however, during the ruling of King Shaka Zulu, circumcision was abolished. It was only in 2010 that it was re-introduced, but this time in the form of medical male circumcision. The aim was to circumcise as many men as possible to avert new human immunodeficiency virus (HIV) infections, but few males utilise the circumcision services. AIM: The aim of this study was to gain an understanding of the factors that hinder effective uptake of medical male circumcision. SETTING: This study was conducted at Untunjambili area under iLembe district in KwaZulu-Natal province. METHODS: This qualitative, exploratory, descriptive and contextual study was conducted using in-depth unstructured face-to-face individual interviews at Untunjambili area under iLembe district in KwaZulu-Natal. A convenience sampling method was employed and participants aged between 18 and 49 years participated in the study. RESULTS: Factors that hinder effective uptake of medical male circumcision are organised into five categories: (1) fear (fear of pain, fear of death, fear of HIV test and fear of delayed wound healing, (2) personal factors (age at circumcision, lack of role models, procrastination and lack of volition, fertility and faithfulness), (3) knowledge deficit on circumcision, (4) influence of culture and (5) natural circumcision. CONCLUSION: Factors that hinder effective uptake of medical male circumcision services are manifold. Cultivating a positive attitude towards medical male circumcision can promote uptake of circumcision services and a supportive social support system of men needs to be utilised to encourage men to be circumcised. <![CDATA[<b>Cardiovascular and metabolic risk factors of shift workers within the automotive industry</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100038&lng=pt&nrm=iso&tlng=pt BACKGROUND: Previous research highlighted the importance of identifying the modifiable risk factors among shift workers in specific industries to take effective preventative and therapeutic steps to decrease the risks associated with non-communicable chronic diseases AIM: The aim of this study was to investigate the prevalence of cardiovascular and metabolic disease risk factors among shift workers within the automotive industry. SETTING: This study was conducted at a car manufacturing company in the Eastern Cape Province of South Africa. METHODS: The study employed a cross-sectional quantitative design. Body mass index was calculated, and the American College for Sports Medicine classification for normal weight, overweight and obesity was used to assess the weight status of the workers. Fasting blood glucose and cholesterol as well as blood pressure (BP) were also measured. RESULTS: Seventy-five automotive shift workers participated in the research. Twenty-three per cent of the participants had no risk factors, 30.6% had one risk factor, 34.7% had two risk factors and only 5.3% exhibited four risk factors. Sixty-six percent of participants were classified as either pre-obese or obese, while 55% were hypertensive. Systolic BP (r = 0.258; p < 0.05), diastolic BP (r = 0.342; p < 0.01), cholesterol (r = 0.258; p < 0.05) and age (r = 0.271; p < 0.05) significantly correlated with body mass index CONCLUSION: This study highlights the prevalence of risk factors for cardiovascular diseases among employees in the automotive industry. However, it does not show any risk factors for metabolic diseases. <![CDATA[<b>Describing compassion fatigue from the perspective of oncology nurses in Durban, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100039&lng=pt&nrm=iso&tlng=pt BACKGROUND: Caring for cancer patients can take a toll on the emotional health of oncology nurses, which may lead to compassion fatigue, resulting in decreased quality of nursing care, absenteeism and decreased retention of staff AIM: The aim of this study was to describe compassion fatigue from the perspective of oncology nurses. This study is part of a larger mixed-methods action research study to develop an in-facility intervention to manage compassion fatigue in oncology nurses SETTING: This study was conducted at Durban, KwaZulu-Natal, South Africa. METHODS: The research setting comprised one state hospital (with oncology clinics and wards), a private hospital (with oncology wards) and a hospice in Durban, KwaZulu-Natal, South Africa. Semi-structured individual interviews (guided by Figley's Compassion Fatigue Process, 2005) were conducted with eight participants. Data were analysed using manifest content analysis. RESULTS: Five categories emerged from the data, namely, emotional connection, emotional fatigue, emotional loss, blurring boundaries and acceptance. CONCLUSION: The findings revealed that oncology nurses are affected emotionally in caring for their patients, thus making them prone to compassion fatigue. Oncology nurses need to acknowledge compassion fatigue and be able to self-reflect on how they are managing (both positively and negatively) with the stressors encountered in the oncology wards or units. <![CDATA[<b>Computer-aided detection tool development for teaching chest radiograph pattern recognition to undergraduate radiography students: A context needs and capability analysis</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100040&lng=pt&nrm=iso&tlng=pt BACKGROUND: Medical imaging (MI) education has experienced a shift aligned with the advances in technology and the role played by radiographers in pattern recognition. This has led to increased use of technology-enhanced teaching and simulated learning approaches (e.g. computer-aided detection [CAD] tools) which also support the increasing requirement to develop pattern-recognition skills at undergraduate level. However, the development of these approaches need to be explored and planned carefully to be context-relevant AIM: The aim of this study was to explore and describe the need for and capability of a CAD tool for teaching chest radiography pattern recognition in an undergraduate radiography programme. SETTING: The setting was a university that offers MI education. METHOD: The study employed a qualitative descriptive design with an interpretive research paradigm. Purposive sampling was used to recruit information-rich participants for a focus group interview. Information-rich participants were considered to be those who were involved in teaching clinical skills, such as those required in pattern recognition, to radiography students. Data were transcribed verbatim and analysed in a step-by-step approach. RESULTS: Three main themes emerged: (1) a structured approach to enhance implicit skills is critical in the CAD tool design; (2) an authentic tool which is able to simulate real-world experiences in image analysis is essential; and (3) a tool which encourages self-directed learning using a wide variety of pathological conditions would be ideal. CONCLUSION: The results of this study are essential in guiding radiography educators in designing CAD tools for teaching chest radiography pattern recognition. <![CDATA[<b>Describing medicine therapy management of type 2 diabetes mellitus at primary health care facilities in Cape Town</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100041&lng=pt&nrm=iso&tlng=pt BACKGROUND: Rational medicine use aims to optimise chronic disease management and prevent episodes of hospitalisation that economically burden the health care system. Diabetes mellitus is one of the most prevalent chronic diseases globally, yet more than 60% of patients with diabetes are not optimally managed according to their therapeutic glycaemic targets. AIM: To describe the use of glycated haemoglobin (HbA1c) and fasting plasma glucose results in guiding treatment changes in patients with type 2 diabetes mellitus. SETTING: Public sector primary health care facilities in the Cape Town Metropolitan Region in South Africa. METHOD: Retrospective, descriptive study design was employed. Data for an 18-month period were collected during 2014 and 2015. Data were collected from patient medical records and included baseline demographics, laboratory monitoring tests and the patients' last three prescriptions. RESULTS: The study consisted of 575 participants (64% female) with an average age of 57 (± 11.38) years. The average baseline HbA1c for 493 participants with at least one result was 8.78% (± 1.63), and only 28% of these participants reached the glycaemic target at consequent consultations. HbA1c levels were available to guide 245 prescription changes, of which 181 of these results were outside of the target range. Of these, 15.5% had appropriate therapy adjustments, 78.4% had no change or a lateral change in their follow-up prescriptions, and 6.1% had therapy adjustments opposite to what guidelines suggest. CONCLUSION: Glycaemic monitoring indicated consistent suboptimal glycaemic control in more than 60% of participants. Medicine prescribing patterns did not align with the prescribed local guidelines, Society for Metabolism, Endocrinology and Diabetes of South Africa (SEMDSA). The appropriate use and interpretation of HbA1c at a clinic level should be emphasised to promote rational use of medicines that minimise acute hospitalisation episodes and optimise patients' long-term health outcomes. <![CDATA[<b>The emerging radiographer's transient community service professional career pathway</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100042&lng=pt&nrm=iso&tlng=pt BACKGROUND: Post-qualification regulatory 12-month community service (CS) was implemented in South Africa in 1998. Since the implementation, studies have been conducted in various disciplines to measure the impact on health services and on the affected professionals, but these did not include radiography professionals. AIM: This study explored the expectations and experiences of student radiographers in respect of the CS concept as an integral transitional career pathway from the student radiographer role to that of a provisional practitioner in transit to acquiring registered radiographer practitioner status. RESEARCH METHODS: The research design entailed a qualitative exploratory approach using a longitudinal data collection approach. That is, data collection from the purposefully selected student radiographers' focus group discussions, as well as from placement institutions' qualified professionals and managers, formed the triangulated data sources. In addition, individual interviews were conducted post-placement until data and thematic saturation had been reached. Tesch's (1990) method was used for the data interpretation and analysis RESULTS: The themes that emerged reflected the preparedness of these students to fulfil the requirements, their experiences of their anticipated placement institution, preparedness for their roles and responsibilities and uncertainties about their readiness for the actual encounter. A golden thread throughout was critical self-reflection on their ability, adaptability and capability to meet the requirements of the system, namely the community placement institutions and appeasing the Department of Health. CONCLUSION: The study illustrates, by means of a framework, the student radiographers' journey in transit to acquiring eligibility as registered radiography practitioners in a regulated career pathway. <![CDATA[<b>Nurses' perspectives of the nursing documentation audit process</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100043&lng=pt&nrm=iso&tlng=pt BACKGROUND: Nursing has an obligation to the public to develop measures for the quality of care to enhance patient safety and efficiency of the system. The first hospital to introduce the clinical audit of nursing documentation was in Abu Dhabi. The rationale was the recognition of the link between clinical audits and the quality of patient care and safety. This article recognises the importance of documentation audits in nursing practice and the role of nurses related to conducting audits in a selected hospital in Abu Dhabi. Many studies have shown the potential benefits of documentation audits to evaluate or assess the quality of recorded nursing assessments and care. AIM: The aim of this study was to explore nurses' perspectives of the documentation audit process. METHOD: The study adopted an exploratory, descriptive qualitative approach using the evaluation method. Data were collected using three focus group interviews consisting of 4 informatics and 13 documentation link nurses involved in the implementation of the clinical audit on nursing documentation in the selected hospital. Thematic analysis was used to analyse the data. RESULTS: Three major themes evolved from the research findings: implementation of documentation audit, evaluation of audit and measures to improve documentation audit. Strengths and weaknesses of the documentation audit were articulated by the nurses. Generally, nurses were satisfied with the audit process and made recommendations on improvements. CONCLUSION: Processes adopted by the team were reasonable and useful, and the preparation and planning for the clinical audit were regarded as areas of strength. Areas of weaknesses in the implementation processes identified included dissemination of findings and executing improvements. This could be improved with necessary support from the hospital management, especially with regard to release time to implement required changes. The complexity of auditing electronic versus paper-based nursing documentation is acknowledged. <![CDATA[<b>Ultrasound biosafety: Knowledge and opinions of health practitioners who perform obstetric scans in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100044&lng=pt&nrm=iso&tlng=pt BACKGROUND: Diagnostic ultrasound is generally considered as a safe test in pregnancy. To date there is no evidence that ultrasound has caused harm to the developing foetus. However, with the number of obstetric scans on the rise and the steep increase in acoustic output achieved by modern machines, the lack of evidence of absolute safety remains a concern. Acoustic output is under the direct control of the operator and is therefore the operator's responsibility to keep the intensity as low as reasonably achievable. A situation analysis in the South African context was deemed necessary to determine end user knowledge and opinions on safe antenatal ultrasound practice. AIM: The aim of this quantitative descriptive, cross-sectional study was to evaluate the knowledge and practice of health practitioners who perform antenatal scans regarding safety aspects of diagnostic ultrasound. SETTING: A self-administered questionnaire was distributed at two national congresses, hosted by the South African Society of Ultrasound and Obstetrics (SASUOG) and South African Society of Obstetricians (SASOG) committees. METHOD: Quota non-probability sampling allowed for the identification of professional categories capable of providing information relevant to the study objectives. The sample represented a population with experience in obstetric ultrasound. RESULTS: Compared to international studies, South African end users demonstrated better knowledge of safety indices than their international counterparts. It is, however, discouraging that end users still demonstrate insufficient knowledge regarding factors contributing to adverse biological effects. CONCLUSION: With room for improvement, an effort should be made to comply with international standards through increased training efforts and raising awareness. <![CDATA[<b>Community service nurses' experiences regarding their clinical competence</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100045&lng=pt&nrm=iso&tlng=pt BACKGROUND: In South Africa, it is mandatory for nurses who have qualified as a nurse (general, psychiatric and community) and midwifery, leading to registration in Government Gazette Notice No. R425 of 22 February 1985, to perform 12 months' compulsory community service after completion of training at a College of Nursing. Community service affords new graduate nurses the opportunity to improve their clinical skills and knowledge while nurturing professional behavioural patterns and critical thinking consistent with the profession AIM: To explore and describe the experiences of community service nurses (CSNs) regarding clinical competence during their placement in three selected hospitals. SETTING: The study setting was North West Province (NWP), South Africa. METHOD: This study followed a qualitative, exploratory, descriptive and contextual research design. A cluster sampling technique was used and 17 CSNs participated in the study. Three focus group discussions framed by semi-structured questions were conducted with five to six participants per group. All discussions were recorded using a digital voice recorder and transcribed. Data were analysed using Pienaar's four steps of qualitative thematic analysis. RESULTS: Four themes emerged from this study: facilitative experiences, defacilitative experiences, challenges confronted during placement and suggestions to improve clinical competence. CONCLUSION: Clinical competence of CSNs could be improved if all the stakeholders, including professional nurses and CSNs themselves, hospital management and the regulatory body, the South African Nursing Council, collaborate. More importantly, this study's results were used to develop a clinical competence evaluation tool in the NWP, South Africa. <![CDATA[<b>Nutritional status and dietary diversity of pregnant women in rural KwaZulu-Natal, South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100046&lng=pt&nrm=iso&tlng=pt BACKGROUND: Pregnancy is a critical period during which maternal nutrient intake and nutritional status impact both the mother and the infant. Various factors including good nutrition play a role in a healthy pregnancy outcome. A healthy diet has an important role in the birthweight and well-being of both the mother and the child. AIM: The aim of this descriptive study was to determine the nutritional status and food intake of a group of pregnant women (N = 100) in early pregnancy (up to 24 weeks gestation). SETTING: The study took place in a Public Health Care Facility located at Umkhumbane (Mayville) and forms part of the EThekwini district operated by the Provincial and eThekwini Municipality situated in Kwa Zulu Natal, South Africa. METHODS: This study utilised a quantitative, descriptive research design and included 100 pregnant women attending a public healthcare clinic in KwaZulu-Natal province, South Africa. Consenting women were measured for height and weight to determine body mass index (BMI) as an indicator of nutritional status. Food intake was evaluated through two 24-h dietary recall questionnaires and a food frequency questionnaire. Actual food intake was analysed for nutrient content and compared to the Dietary Reference Intake for women aged 19-30 years. A food variety score and food group diversity score were determined to establish the adequacy of the diet to support the first phase of pregnancy. RESULTS: Except for carbohydrates and vitamin A, all the nutrients consumed by the women were lower than the recommended daily amounts. Fruit and vegetable intake was half of the recommended daily amount and a medium food variety score was observed. A large percentage (55%) of the women had a BMI that fell in the obese category. CONCLUSION: Although various factors can impact birth outcome, food choices made by women did not reflect the food choices to maintain a healthy pregnancy and contribute to a healthy birth outcome. Nutrition education aimed at girls of childbearing age and pregnant women is important to increase their awareness about a healthy pregnancy and healthy birth outcome. <![CDATA[<b>Demographic and socio-economic predictors of physical activity among people living with HIV of low socio-economic status</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100047&lng=pt&nrm=iso&tlng=pt BACKGROUND: Physical activity (PA) is beneficial for the health of people living with HIV and AIDS (PLWHA). AIM: The aim of this study was to determine if age, body weight, height, gender, waist-to-hip ratio (WHR), educational attainment, employment status, CD4+ cell count and body mass index (BMI) can predict overall PA among PLWHA of low socio-economic status (SES SETTING: Participants in this study were HIV-infected patients on first-line antiretroviral therapy (ART) regimen offered by the South African National Department of Health, and those not on ART. Participants were conveniently sampled from a list at a community health care centre in Cape Town. METHODS: This study sample consisted of 978 HIV-infected South Africans. Physical activity data were collected using the Global Physical Activity Questionnaire. Backward multiple linear regression modelling was used to determine the relative influence of variables (age, body weight, height, gender, WHR, educational attainment, employment status, CD4+ count and BMI) on total moderate-to-vigorous PA. Alpha level was set at 0.05. RESULTS: The mean age of the participants was 38.2 (standard deviation [SD] = 8.76) years for men and 33.9 (SD = 8.53) years for women. Physical activity was significantly higher in men (480.2 [SD = 582.9] min/week) than among women (369.35 [SD = 222.53] min/week). The results of the multiple linear regression showed that educational attainment (β = 0.127; p = 0.00), employment (β = −0.087; p = 0.01) and gender (β = 0.235; p = 0.00) significantly predicted total moderate-to-vigorous PA. Gender had the greatest effect, followed by educational attainment and employment status. CONCLUSION: There is a need for PA programmes that are designed to (1) target women, (2) strengthen programmes for education and promotion of PA and (3) engage the unemployed into PA for PLWHA. Physical activity interventions for this particular group should be tailored for persons of low SES. <![CDATA[<b>Determinants of the utilisation of sexual and reproductive healthcare services by male adolescents in the Tshwane Metropolitan Municipality in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100048&lng=pt&nrm=iso&tlng=pt BACKGROUND: Male adolescent sexual and reproductive health is one of the essential healthcare programmes in the world. However, male adolescents still face numerous challenges in this area. Determinants of the utilisation of these services need to be known to develop strategies to improve utilisation of the available services by male adolescents. AIM: The aim of this study was to identify the determinants of the utilisation of sexual and reproductive healthcare services by male adolescents in the Tshwane Metropolitan Municipality in South Africa. SETTING: The study was conducted in the Tshwane Metropolitan Municipality in South Africa. METHODS: An explorative, descriptive and qualitative approach was employed. The study was contextual in nature, and purposive sampling was used. The population of the study consisted of male adolescents (aged 18-24 years) living in the Tshwane metropolitan Municipality. Twenty male adolescents participated in the study. Data collected using semistructured individual interviews were analysed using Tesch's method of data analysis, and measures to ensure trustworthiness and ethical consideration pertaining to the study were established RESULTS: The perception of existing services was found to be a significant individual factor influencing them negatively in utilising the services. This was linked to the violation of their rights as human beings by healthcare providers, their unmet expressed needs and the ineffectiveness as well as inefficiency of the support structures. CONCLUSION: These results suggest that utilisation of these services by male adolescents can be improved by changing their perception of the existing services through support from different structures of the society. <![CDATA[<b>Conflict pressure cooker: Nurse managers' conflict management experiences in a diverse South African workplace</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100049&lng=pt&nrm=iso&tlng=pt BACKGROUND: Nurse managers are central to conflict management and a healthy work environment. South Africa is one of the most diverse countries globally and workplace diversity is a reality in healthcare organisations. There is a gap in academic literature on conflict management by nurse managers in diverse workplaces in South Africa. AIM: This research aims to understand nurse managers' experiences of conflict management within a diverse South African workplace (military hospital) in order to facilitate a healthy work environment. SETTING: The context was a diverse, medical military organisation servicing all nine South African provinces. This military hospital employed staff of varying nationalities, catering to military and private patients, and functioned within a strict hierarchical structure METHODS: Purposive sampling was used. Thirteen unstructured, individual interviews were conducted based on a qualitative, phenomenological design. The interviews were followed by content analysis and five main themes emerged as a result RESULTS: A hierarchical, diverse organisational culture complicates conflict management. The ranking structure, resource shortages, intergenerational dynamics, poor communication and distrust cause conflict. Nurse managers experience conflict daily and are central to conflict management. As such, they have certain personal characteristics and display specific conflict management skills. Conflict management skills can be taught, but this requires an intra- to interpersonal process. A major challenge for the nursing profession today is the younger nurses who seem less passionate and nurse managers who are under more pressure than before. CONCLUSION: A medical military organisation presents an organisational culture that combined with diversity is predisposed to conflict, which endangers the work environment. Yet, both conflict and workplace diversity can, when managed correctly, enrich a healthcare organisation. Nurses and nurse managers will benefit from reflective conflict management training as an intra- to interpersonal process. <![CDATA[<b>The relationship between nutrition reading and label use and nutrition knowledge amongst a sample of rural youth studying at a university in South Africa</b>]]> http://www.scielo.org.za/scielo.php?script=sci_arttext&pid=S2071-97362019000100050&lng=pt&nrm=iso&tlng=pt BACKGROUND: Within rural communities, quests for understanding consumer behaviour patterns become key, especially given the challenges that exist in such communities. Furthermore, youth consumers are an important cohort in rural communities in South Africa. Yet little empirical work has been conducted in studying their consumptive habits (usually in favour of youths in urban areas). AIM: This study sought to measure the relationship between nutrition label use and nutrition knowledge amongst a sample of rural youth. This also included ascertaining the roles of demographic variables such as (1) gender and (2) and the number of years in tertiary education in this relationship. SETTING: The study was located within a South African rural context using a sample of rural youths. METHOD: A quantitative study was utilised by means of a self-administered questionnaire, involving 150 youths residing in a rural community located in the Eastern Cape province of South Africa. Inferential statistical analysis was conducted using correlation tests, analysis of variance and linear regression. RESULTS: Three main findings emerged. Firstly, rural youth consumers' nutrition label use had no significant relationship with nutrition knowledge. Secondly, no significant difference existed by gender concerning nutrition knowledge. Finally, the level of education amongst the rural youth consumers had no relationship with aspects of nutrition knowledge. CONCLUSION: Based on the findings, recommendations are made not only for theory and practice but also for policy in relation to both the rural context and for optimal health.